Distinguished Alumni Award

Nomination Form

 

After completing this form, please press the Submit button to e-mail your nomination LCC Foundation and Alumni Association. Or if you prefer, you may type or write your answers on plain paper and mail to:

LCC Foundation and Alumni Association

200 South 14th Street

Parsons, KS 67357

 

If you have questions, please e-mail Lindi Forbes at lindif@labette.edu, or telephone the LCC Alumni Association at (620) 820-1212.

 

Thank you for your help with this important project.

Date: (mm/dd/yyyy)

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Nominee's Information

First Name: MI: Last Name:    Maiden Name:
     
Address:      
   
City: State:

Zip Code:

Year Graduated LCC:
     

 
Phone Number (with area code): E-Mail Address:  
    -    
Spouse's Name:      
       

Colleges & Universities Attended:
 
 
 
 

Employer and Location:

Job Title/Assignment:

Previous Employers (include dates, company name, location, title and assignment):
   
   
   
   
   

Memberships & Offices (including professional, religious and civic organizations):
 
 
 
 
 

Community Activities, Honors and Awards:
 
 
 
 
 
 
 
 

Books or Articles Published:
 
 
 

Military Service & Responsibilities:
 
 
 

Other information you wish to share about the nominee:

--------------------------------- Thank You ----------------------------------------

Nominator's Information

Name:

Address:   

City:      State:     Zip Code:

Daytime Phone Number (with area code):    -

E-Mail Address: